MEDICARE: MR. SUNG JIN PARK PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	60815	CA

General Provider Information

NPI Number	:	1093457194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SUNG JIN PARK PA-C

Provider Business Mailing Address
First Line	:	2160 BARRANCA PKWY # 1018
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92606-4940
Country	:	US
Telephone Number	:	949-939-6780
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 FAIRVIEW RD
Second Line	:
City	:	HOLLISTER
State	:	CA
Zip	:	95023-9644
Country	:	US
Telephone Number	:	714-545-5550
Fax Number	:	949-609-0374

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2022
Last Update Date	:	12/02/2025

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Directions to “ MR. SUNG JIN PARK PA-C” Practice Location

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